目的:评估临床鉴定HD-CVC中ESI和TI的体征和症状的相关性,通过国际专家共识,并就这些感染的定义和临床管理(CM)达成共识。
背景:最近的一项系统评价显示,用于确定血液透析中心静脉导管(HD-CVC)出口部位感染(ESI)和隧道感染(TI)的体征/症状存在高度异质性。
方法:在2020年11月至2021年3月之间进行了修改的Delphi排名过程,包括四轮使用在线问卷,由来自12个国家的26名专家组成。
方法:专家对ESI和TI的识别的相关性水平做出了回应,根据从先前的系统评价中获得的22种体征/症状列表,使用4点Likert型量表。在对体征/症状达成共识后,他们遵循相同的方法就CM达成共识。使用STROBE检查表报告本研究。
结果:根据九种体征/症状,达成了高度共识以确定ESI的存在:透析间期出口部位(ES)存在疼痛,发烧≥38°C不要怀疑其他原因,ES的局部体征(炎症,硬结,肿胀,距ES≥2cm的充血/红斑)和明显的脓肿或脓性渗出液;和TI。同样,5厘米同意。
结论:这项Delphi研究提供了HD-CVC中ESI和TI的国际专家共识定义,为早期识别ESI的HD-CVCES临床评估量表的验证奠定基础。
结论:此外,这项研究提供了一系列关于HD-CVC局部感染的体征/症状的共识诊所的态度,作为临床实践指南中的专家意见,当科学证据不足时。
OBJECTIVE: To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD-CVC, by means of international expert
consensus, and to reach a
consensus on a definition and clinical management (CM) for these infections.
BACKGROUND: A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD-CVC).
METHODS: A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries.
METHODS: Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4-point Likert-type scale. After reaching
consensus on the signs/symptoms, they followed the same method to reach
consensus on the CM. The STROBE Checklist was used to report this study.
RESULTS: A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon.
CONCLUSIONS: This Delphi study provides international expert
consensus definitions of ESI and TI in HD-CVC, laying the groundwork for the validation of an HD-CVC ES clinical assessment scale for early identification of ESI.
CONCLUSIONS: In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD-CVC, which may be useful as expert opinion in clinical practice
guidelines, when there is insufficient scientific evidence.